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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Bladder Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 21440184
AU - Kochakarn W; Chaimuangraj S; Leenanupunth C; Muangman V
TI -
Risk factors of urethral involvement of bladder cancer after radical
cystectomy with orthotopic neobladder in females.
SO - J Med Assoc Thai 2001 Jun;84(6):889-92
AD - Department of Surgery, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand.
The cystectomy and urethrectomy specimens of 20 females with invasive
bladder cancer were studied for evidence of urethral involvement. The
bladder showed transitional cell carcinoma in 18 cases (90%) and
squamous cell carcinoma in 2 cases (10%). Urethral involvement was found
in 5 cases (25%). The trigone was the most common site of tumor (50%)
which had 33 per cent chance of urethral involvement. Bladder neck was
the next common site of tumor (15%) and had 66 per cent chance of
urethral involvement. High stage (T3b, T4) and high grade (III) at
trigone also correlated with urethral involvement. The tumor bearing
node showed only 20 per cent correlation with urethral involvement.
Female patients with high stage/high grade at trigone and any
stage/grade at bladder neck are at high risk of urethral recurrence
after radical cystectomy and orthotopic neobladder procedure.
2
UI - 21268708
AU - Cohen EE; Stadler WM
TI -
Treatment of metastatic urothelial cancer in the post-MVAC era.
SO - World J Urol 2001 Apr;19(2):126-32
AD - Section of Hematology/Oncology, Department of Medicine, University of
Chicago, Chicago, Illinois, USA.
The combination of methotrexate, vinblastine, doxorubicin, and cisplatin
(MVAC) has become the standard of care for metastatic urothelial cancer.
Its efficacy has been proven in this setting but it can be a difficult
regimen to tolerate. With the introduction of new active agents,
different combinations are being evaluated. This article will highlight
the use of these new regimens with emphasis on those employing
gemcitabine or the taxanes.
3
UI - 21268709
AU - Lehmann J; Retz M; Stockle M
TI -
The role of adjuvant chemotherapy for locally advanced bladder cancer.
SO - World J Urol 2001 Apr;19(2):133-40
AD - Department of Urology, University Saarland, 66421 Homburg/Saar, Germany.
jan.lehmann@med-rz.uni-saarland.de
The incidence of locally advanced bladder cancer is estimated at 5 new
cases per 100,000 of the population annually in North America and most
European countries. Radical cystectomy for muscle-invasive
organ-confined tumors and locally advanced disease, which is defined as
extravesical tumor growth or involvement of regional lymph nodes, is the
preferred treatment in Japan, the United States, and in some countries
of Europe. The clinical outcome of radical cystectomy has improved
remarkably over the past 20 years as a result of advances in operative
technique and perioperative care. Nevertheless, at least 50% of patients
with invasive bladder cancer are expected to develop progressive disease
within the first 2 years when treated with radical cystectomy alone. In
order to improve the fate of muscle-invasive and locally advanced
disease, the administration of additional therapy to definite treatment
has been studied in various forms, such as neoadjuvant and adjuvant
systemic chemotherapy as well as combined radio-chemotherapy. Prolonged
progression-free survival for patients suffering from locally advanced
bladder cancer by administration of adjuvant systemic chemotherapy has
been suggested by three randomized studies, published by Skinner, Freiha
and Stockle since 1991. These studies demonstrated a disease-free
survival benefit of 17-50% within the first 3-5 years when applying
adjuvant systemic chemotherapy after radical cystectomy. Patients who
most likely benefit from adjuvant chemotherapy are those with limited
node-positive disease, extravesical tumor, and direct invasion into
adjacent viscera, such as prostate, uterus, or vagina. This review will
summarize past, current, and future aspects of systemic adjuvant
chemotherapy for transitional cell carcinoma of the bladder.
4
UI - 21268704
AU - Sternberg CN; Calabro F
TI -
Neo-adjuvant chemotherapy in invasive bladder cancer.
SO - World J Urol 2001 Apr;19(2):94-8
AD - Vincenzo Pansadoro Foundation, Via Aurelia 559, Rome, 00165 Italy.
cstern@mclink.it
In patients with locally advanced muscle-invasive bladder cancer,
neo-adjuvant chemotherapy was designed to treat micrometastatic disease
present in up to 50% of patients at the time of diagnosis. Early
chemotherapy has been combined with local therapy based on the reasoning
that treatment of small volume disease would result in a better outcome.
Another reason for giving neo-adjuvant chemotherapy is in an attempt to
save the bladder. In selected patients, bladder preservation can be
achieved with the use of chemotherapy plus radiotherapy, partial
cystectomy, or transurethral resection of the bladder (TURB).
Neo-adjuvant chemotherapy and bladder preservation remain controversial
topics, as radical cystectomy is still considered to be the gold
standard of treatment for muscle-invasive bladder cancer. The true
success of bladder-preserving treatment by chemotherapy with or without
RT will require validation in prospective randomized trials.
5
UI - 21384900
AU - Oosterlinck W
TI -
Recent clinical trials in superficial bladder cancer.
SO - Curr Opin Urol 2001 Sep;11(5):511-5
AD - Department of Urology, University Hospital Ghent, Ghent, Belgium.
willem.oosterlinck@rug.ac.be
The present review addresses literature regarding the management of
definitive winner among urinary markers of bladder cancer, because they
lack specificity or are insufficiently tested. Pathologists continue in
their efforts to improve prediction of evolution of superficial bladder
cancer to recurrent or infiltrative disease. A few studies have
confirmed the value of previously described prognostic factors for
recurrence and progression, and have added some refinements.
Transurethral resection is not as complete as was believed. Fluorescence
detection of flat bladder carcinoma has been demonstrated to improve
diagnosis and treatment. The necessity to perform a repeat transurethral
resection in high-grade superficial bladder cancer became evident.
Identification of the working mechanisms of bacille Calmette-Guerin on
superficial bladder cancer remains an important objective, and may help
to improve treatment schedules and avoid the morbidity associated with
bacille Calmette-Guerin administration. Patients who are at high risk
may benefit from long-term maintenance bacille Calmette-Guerin therapy.
Valrubicin and keyhole limpet haemocyanin appear to be promising agents
in the treatment of superficial bladder cancer.
6
UI - 21384901
AU - Bellmunt J; Albiol S
TI -
New chemotherapy combinations for advanced bladder cancer.
SO - Curr Opin Urol 2001 Sep;11(5):517-22
AD - Medical Oncology Service, General University Vall d'Hebron Hospital,
Barcelona, Spain. bellmunt@hg.vhebron.es
Transitional cell carcinoma of the urothelium is considered a
chemosensitive malignancy. Until recently, the methotrexate,
vinblastine, doxorubicin and cisplatin combination has been considered
the standard for treating this disease. The development of new
chemotherapeutic agents such as gemcitabine and the taxanes has opened
up promising new perspectives in the treatment of this disease. However,
the preliminary phase II data must be confirmed in adequately conducted
phase III trials.
7
UI - 21384902
AU - Sternberg CN
TI -
Second-line treatment of advanced transitional cell carcinoma of the
urothelial tract.
SO - Curr Opin Urol 2001 Sep;11(5):523-9
AD - Vincenzo Pansadoro Foundation, Clinic Pio XI, Rome, Italy.
cstern@mclink.it
Cisplatin-based combination chemotherapy such as methotrexate,
vinblastine, adriamycin and cisplatin produces durable improvements in
survival in only a minority of patients. Therefore, other therapeutic
options and strategies are clearly needed. Strategies include increasing
the dose of chemotherapy, modifying the sequencing of chemotherapy, and
new therapeutic agents. This paper reviews recent work on high-dose
chemotherapy, currently available chemotherapeutic agents and
combinations, with an emphasis on gemcitabine and the taxanes. New
strategies such as monoclonal antibody therapy and molecular targeted
small molecule therapy are becoming a reality in the treatment of many
diseases. The rationale for using epidermal growth factor receptor
targeted therapies is also reviewed.
8
UI - 21356595
AU - Game X; Soulie M; Seguin P; Vazzoler N; Tollon C; Pontonnier F; Plante P
TI -
Radical cystectomy in patients older than 75 years: assessment of
morbidity and mortality.
SO - Eur Urol 2001 May;39(5):525-9
AD - Department of Urology and Andrology, Rangueil University Hospital,
Toulouse, France.
OBJECTIVE: We have reviewed our surgical experience to assess intra- and
postoperative morbidity and mortality in 25 patients 75 years old or
older with invasive bladder cancer who underwent radical cystectomy and
men and 2 women were aged from 75 to 87 (median 79) years. Urinary
diversion was performed in 23 cases and bladder substitution in 2. All
patients had significant comorbidity and 15 patients were ASA II and 10
ASA III. RESULTS: Median operating time was 4 h. Perioperative mortality
rate was 4%. Intraoperative, early and late postoperative complications
occurred in 15, 16 and 6 patients, respectively. The most common early
complications were pyelonephritis (32%), disorientation (20%),
additional pulmonary infection (20%) and prolonged ileus (32%). No
secondary procedures were necessary. The most common late complication
was ureteroileal anastomotic stricture (16%). The median hospital stay
and intensive care unit stay were 24 and 14 days, respectively. With a
median follow-up of 14 (5-50) months the overall mortality rate was 32%.
CONCLUSIONS: Radical cystectomy can be performed in elderly patients
with acceptable perioperative mortality and morbidity. However, because
of the high incidence of minor medical complications, hospital stay is
often prolonged.
9
UI - 21444663
AU - Paroni R; Salonia A; Lev A; Da Pozzo LF; Cighetti G; Montorsi F; Rigatti
TI -
P; Colombo R
Effect of local hyperthermia of the bladder on mitomycin C
pharmacokinetics during intravesical chemotherapy for the treatment of
superficial transitional cell carcinoma.
SO - Br J Clin Pharmacol 2001 Sep;52(3):273-8
AD - Department of Laboratory Medicine, IRCCS H San Raffaele, via Olgettina
60,20132 Milan, Italy. paroni.rita@hsr.it
AIMS: To assess the effect of local hyperthermia on the systemic
absorption of mitomycin C (MMC) during intravesical chemotherapy for the
treatment of superficial transitional cell carcinoma of the bladder, and
to establish the likely safety of this procedure. METHODS: Group 1 (n =
12) received 20 mg intravesical MMC plus local hyperthermia, group 2 (n
= 13) 20 mg MMC alone, group 3 (n = 16) 40 mg MMC plus local
hyperthermia and group 4 (n = 10) 40 mg MMC alone. Patients in groups 1,
2, and 4 underwent post-tumour resection adjuvant treatment, whereas
those in group 3 still had tumour present and were treated to eradicate
it. Intravesical instillation lasted 60 min, with the solution (50 ml)
being replaced after the first 30 min. Blood samples were taken before,
and every 15 min during instillation. MMC concentrations in plasma and
in urine were determined by h.p.l.c. RESULTS: The highest MMC plasma
concentration (67.9 ng ml(-1)) occurred in a patient in group 3. This
value was well below the threshold concentration (400 ng ml-1) for
myelosuppression. Local hyperthermia associated with the intravesical
chemotherapy enhanced plasma MMC concentrations at 30, 45 and 60 min
compared with chemotherapy alone (Group 1 vs 2, P < or = 0.008).
Systemic exposure to MMC was not significantly increased by doubling the
intravesical dose when intravesical chemotherapy alone was administered.
Patients in group 3 displayed the highest degree of MMC absorption and
the greatest variability in pharmacokinetics between patients.
CONCLUSIONS: Local hyperthermia enhances the systemic absorption of MMC
during intravesical chemotherapy for bladder cancer. In the doses used,
plasma MMC concentrations were always more than six times lower than
those shown to cause toxicity.
10
UI - 21448058
AU - Bonfil RD; Gonzalez AD; Siguelboim D; Cuello Carrion FD; Ciocca DR;
TI -
Villaronga A; Metz L; Mosso F; Fayad E; Reale M; Schmilovich AJ
Immunohistochemical analysis of Ki-67, p21waf1/cip1 and apoptosis in
marker lesions from patients with superficial bladder tumours treated
with vinorelbine intravesical therapy in a preliminary phase I trial.
SO - BJU Int 2001 Sep;88(4):425-31
AD - Laboratory of Fundacion de Investigacion del Cancer at CEFYBO, Buenos
Aires, Argentina. fundic@velocom.com.ar
OBJECTIVE: To investigate Ki-67 and p21Waf1/Cip1 expression and
apoptosis, before and after treatment, in tumour biopsies obtained from
patients with superficial bladder cancer who underwent vinorelbine
intravesical therapy. PATIENTS AND METHODS: Twenty patients with
high-risk superficial bladder cancer (including one or more of the
following parameters: tumour diameter > 3 cm, histological grade 3, or
multicentric tumours) were treated 1-6 times (weekly) with intravesical
vinorelbine (50 mg/mL) instillations. Transurethral tumour marker
biopsies were obtained one week before the first instillation of the
drug and one week after the last. The biopsies were immunostained for
Ki-67 and p21Waf1/Cip1 with monoclonal antibodies, on tissue sections
derived from paraffin-embedded samples obtained before and after
vinorelbine treatments. In addition, apoptosis was determined using a
terminal deoxynucleotidyl transferase-mediated dUTP biotin nick-end
labelling (TUNEL) technique. RESULTS: There were no significant
differences in the cell proliferation marker Ki-67 in biopsies taken
before or after treatment. However, p21Waf1/Cip1 showed significantly
higher expression in biopsies obtained after vinorelbine treatment, with
median (range) values of 40 (20-90)% before and 70 (50-80)% after (P <
0.001, paired nonparametric Wilcoxon test). The apoptotic index was
significantly higher after vinorelbine therapy, with median (range)
values of 0.89 (0.06-3.8)% before and 2.25 (0.17-18.7)% after treatment
(P < 0.001, paired nonparametric Wilcoxon test). Despite the brief
treatment and few patients there was a clinical response in nine
patients, together with low toxicity in all. CONCLUSION: The
intravesical treatment of tumours with vinorelbine affects p21Waf1/Cip1
expression without blocking cell proliferation, although increasing
apoptosis. The preliminary results suggest that vinorelbine may be
useful for treating superficial bladder tumours, and thus a phase II
study is warranted.
11
UI - 21448060
AU - Dryhurst DJ; Fowler CG
TI -
Flexible cystodiathermy can be rendered painless by using 2% lignocaine
solution to provide intravesical anaesthesia.
SO - BJU Int 2001 Sep;88(4):437-8
AD - Academic Urological Unit, The Royal London Hospital, London, UK.
djdryhurst@mds.qmw.ac.uk
12
UI - 21445101
AU - Bajorin DF
TI -
Plenary debate of randomized phase III trial of neoadjuvant MVAC plus
cystectomy versus cystectomy alone in patients with locally advanced
bladder cancer.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):17S-20S
AD - Genitourinary and Head and Neck Oncology Service, Division of Solid
Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer
Center, New York, NY 10021, USA.
13
UI - 21445102
AU - Sternberg CN; Parmar MK
TI -
Neoadjuvant chemotherapy is not (yet) standard treatment for
muscle-invasive bladder cancer.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):21S-26S
AD - Vincenzo Pansadoro Foundation, Rome, Italy. cstern@mclink.it
14
UI - 21458882
AU - Hara S; Miyake H; Fujisawa M; Okada H; Arakawa S; Kamidono S; Hara I
TI -
Prognostic variables in patients who have undergone radical cystectomy
for transitional cell carcinoma of the bladder.
SO - Jpn J Clin Oncol 2001 Aug;31(8):399-402
AD - Department of Urology, Kobe University School of Medicine, Kobe, Japan.
OBJECTIVE: To evaluate whether several clinicopathological factors could
be used as prognostic predictors in patients who have undergone radical
cystectomy for transitional cell carcinoma (TCC) of the bladder.
radical cystectomy and pelvic lymphadenectomy for TCC of the bladder at
a single institution. Their clinicopathological findings were analyzed
based on the criteria of the Japanese Urological Association. RESULTS:
Histopathological examination revealed that the tumor grade was 1 or 2
in 22 patients and 3 in 132 patients; the pathological stage was pT1 or
less in 30 patients, pT2 in 51 patients, pT3 in 53 patients and pT4 in
20 patients. Vascular involvement and lymph node metastasis were found
in 85 and 33 patients, respectively. The cause-specific 5-year survival
rate was 64.2% for all patients, 74.4% for patients with grade 1 or 2
tumors, 62.9% for those with grade 3 tumors; 90.9% for those with stage
pT1 or less, 77.9% for those with stage pT2, 45.0% for those with stage
pT3 and 29.2% for those with stage pT4 (p < 0.001); 83.2% for patients
without vascular involvement and 42.0% for those with vascular invasion
(p < 0.001); and 76.5% for patients without lymph node metastasis and
22.7% for those with lymph node metastasis (p < 0.001). Multivariate
analysis revealed a strong independent correlation of the pathological
stage and lymph node metastasis with poor prognosis and, furthermore,
the incidence of lymph node metastasis was significantly related to the
increase in pathological stage. CONCLUSIONS: In this series, the
pathological stage, lymph node metastasis and vascular involvement, but
not tumor grade, were significantly useful prognostic factors in
patients who have undergone radical cystectomy for TCC and among them
only pathological stage and lymph node metastasis could be used as
independent predictors for poor prognosis.
15
UI - 21180951
AU - Lockyer CR; Gillatt DA
TI -
BCG immunotherapy for superficial bladder cancer.
SO - J R Soc Med 2001 Mar;94(3):119-23
AD - Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym,
Bristol BS10 5NB, UK. richardlockyer@bui.ac.uk
16
UI - 21281172
AU - Lane T
TI -
BCG immunotherapy for superficial bladder cancer.
SO - J R Soc Med 2001 Jun;94(6):316
17
UI - 21287667
AU - Pietrow PK; Smith JA Jr
TI -
Laser treatment for invasive and noninvasive carcinoma of the bladder.
SO - J Endourol 2001 May;15(4):415-8; discussion 425-6
AD - Department of Urologic Surgery, Vanderbilt University Medical Center,
Nashville, Tennessee 37232-2765, USA.
Lasers are widely used in urologic surgery and have many well-developed
applications. The use of lasers for the treatment of bladder cancer has
been proven to be safe and minimally invasive. The neodymium:YAG laser
is the most widely used instrument, although the holmium:YAG laser has
also gained recent popularity. Noninvasive, small lesions are especially
amenable to management with laser energy and have been treated with
success rates that are at least as good as those of standard
electrocautery resection. Complication rates are low. Laser therapy of
invasive bladder cancer has significant limitations and should probably
be restricted to stage T2 lesions.
18
UI - 21287668
AU - Grob BM; Macchia RJ
TI -
Radical transurethral resection in the management of muscle-invasive
bladder cancer.
SO - J Endourol 2001 May;15(4):419-23; discussion 425-6
AD - Department of Urology, SUNY Downstate Medical School, Brooklyn, New York
11203-2098, USA.
The morbidity of radical cystectomy and early reports of good results
have stimulated interest in radical transurethral resection of bladder
tumors (TURBT) for muscle-invasive transitional-cell carcinoma of the
bladder. Various investigators have used surgery alone or with adjuvant
or neoadjuvant chemotherapy or radiation. Further research is necessary
to define the indications, but at present, radical TURBT for
muscle-invasive cancer appears to be appropriate for patients too ill to
undergo radical cystectomy, those who decline the open operation, and
those enrolled in clinical trials of this approach to bladder cancer.
19
UI - 21296265
AU - Ojea Calvo A; Nunez Lopez A; Alonso Rodrigo A; Rodriguez Iglesias B;
TI -
Benavente Delgado J; Barros Rodriguez JM; Nogueira March JL
[Value of a second transurethral resection in the assessment and
treatment of patients with bladder tumor]
SO - Actas Urol Esp 2001 Mar;25(3):182-6
AD - Servicio de Urologia, Hospital Xeral de Vigo, Vigo, Pontevedra.
OBJECTIVE: To analyse the value of a second transurethral resection,
repeated within 3 to 6 weeks after the initial resection, in the
treatment and the classification of patients with bladder tumour.
MATERIAL AND METHODS: We analyse the results of 72 repeated
transurethral resection in 23 (32%) patients with T1 G1-2 bladder tumor,
9 (12.5%) with T1 G3 tumor, 31 (43%) with T2a G2-3 tumor and 9 (12.5%)
with T2b G2-3 tumor. The evaluated patients are not associated with CIS.
RESULTS: Of all 23 T1 G1-2 tumors, 13 (57%) had residual Ta T1 tumor and
1 (4%) T2 tumor. In this group, the second resection changed the
treatment in 1 (4%) patient. Of all 9 T1 G3 tumors, 4 (44%) had residual
T1 tumor and 1 (11%) T2 tumor. In this group the second resection
changed the treatment in 1 (11%) patient. Of all 31 T2a G2-3 tumors, 5
(16%) had residual T1 tumor, 4 (13%) T2 tumor and 6 (19%) T3-T4 tumor.
In this group, the second resection changed the treatment in 10 (32%)
patient. Of all 9 T2b G2-3 tumors, 2 (22%) had residual T1 tumor, 1
(11%) T2 tumor and 2 (22%) T3-T4 tumor. In this group, the second
resection changed the treatment in 3 (33%) patients. CONCLUSIONS: In T1
G1-2 and T1 G3 tumors, a second transurethral resection detect residual
tumor in 36% of patients and change the treatment in 6% of patients. In
T2a-b tumors, a second transurethral resection detect residual tumor in
50% of patients and change the treatment in 33% of patients.
20
UI - 21296266
AU - Paez Borda A; Lujan Galan M; Gomez de Vicente JM; Moreno Santurino A;
TI -
Abate F; Berenguer Sanchez A
[Preliminary results of the treatment of high grade (T1G3) superficial
tumors of the bladder with transurethral resection]
SO - Actas Urol Esp 2001 Mar;25(3):187-92
AD - Servicio de Urologia, Hospital Universitario de Getafe, Madrid.
OBJECTIVE: To examine the results of monotherapy with TUR in the
treatment of primary T1G3 transitional cell carcinoma (TCC).
METHODOLOGY: Thirty-two patients with primary TCC of the bladder were
allocated into a surveillance program. Risk factors for progression to
muscle-invasive disease were determined. Immediately, projections of
disease-free and progression-free survival were calculated. RESULTS:
Five patients (15.6%) were lost in follow-up. Twenty-three (85%) had
superficial recurrences. Four patients (14.8%) progressed to
muscle-invasive or metastatic disease. No independent risk-factors for
progression were disclosed. Median disease-free survival was 8 months.
Projection of the risk of recurrence at 79 months was 84.9%. Median time
to progression has not been reached yet. Projection of progression at 79
months was 46.3%. CONCLUSIONS: The above mentioned treatment schedule is
associated with very high recurrence rates. In addition, recurrences are
very frequent. Nevertheless, in the medium run, projections of
progression suggest that surveillance can be an alternative to other
treatments in the management of T1G3 TCC of the bladder.
21
UI - 99244784
AU - Denewer A; Kotb S; Hussein O; El-Maadawy M
TI -
Laparoscopic assisted cystectomy and lymphadenectomy for bladder cancer:
initial experience.
SO - World J Surg 1999 Jun;23(6):608-11
AD - Mansoura Surgical Oncology Unit, Faculty of Medicine, Mansoura
University, Ghomhoria Street, PO Box 35516-37, Mansoura, Egypt.
This study discusses our initial experience in the field of laparoscopic
management of bladder carcinoma. Ten patients with invasive bladder
tumors of variable histology and ranging from stage T2 to T3b were
submitted to this procedure. Intraoperative assessment, lateral
dissection, posterior dissection, anterior dissection, and urethral
transection were achieved laparoscopically. The specimen retrieval and
continent pouch construction was performed through a limited abdominal
incision. This new regimen allows precise radical lymphadenectomy, early
postoperative mobility, fewer wound complications, and shorter hospital
stay. The early postoperative results of this procedure are encouraging.
Modification and continuous refinement of the technique is still
ongoing.
22
UI - 20521156
AU - Zayyan KS; See WA
TI -
Their initial experience with laparoscopy-assisted cystectomy.
SO - World J Surg 2000 Oct;24(10):1282-3
23
UI - 21468738
AU - Kuznetsov DD; Alsikafi NF; O'Connor RC; Steinberg GD
TI -
Intravesical valrubicin in the treatment of carcinoma in situ of the
bladder.
SO - Expert Opin Pharmacother 2001 Jun;2(6):1009-13
AD - The University of Chicago, Section of Urology, Department of Surgery,
Illinois, USA. dimitrikuznetsov@yahoo.com
The propensity of patients with carcinoma in situ (CIS) of the bladder
to progress to invasive and metastatic disease is clearly established.
Today, the standard therapy in treating patients with CIS of the bladder
is intravesical bacillus Calmette-Guerin (BCG). Nevertheless, patients
who fail intravesical BCG have few viable options except to undergo a
radical cystectomy. Valrubicin (N-trifluoroacetyladriamycin-14-valerate)
is a new semisynthetic derivative of the anthracycline antibiotic
doxorubicin that has been shown to benefit patients with BCG-refractory
CIS of the bladder. Intravesical instillation of valrubicin is
well-tolerated, safe and can be durable. Early non-randomised studies
show promise and the current utilisation of this drug is limited to
patients with BCG-refractory CIS of the bladder who are not good
surgical candidates. Randomised studies of intravesical valrubicin for
the treatment of superficial bladder cancer are ongoing.
24
UI - 21227050
AU - Sakamoto N; Naito S; Kumazawa J; Ariyoshi A; Osada Y; Omoto T; Fujisawa
TI -
Y; Morita I; Yamashita H; The Kyushu University Urological Oncology
Group
Prophylactic intravesical instillation of mitomycin C and cytosine
arabinoside for prevention of recurrent bladder tumors following surgery
for upper urinary tract tumors: a prospective randomized study.
SO - Int J Urol 2001 May;8(5):212-6
AD - Department of Urology, Graduate School of Medical Sciences, Kyushu
University, Japan.
BACKGROUND: A recurrence of bladder tumors following surgery for
transitional cell carcinoma of the upper urinary tract is not rarely
observed. A prospective randomized study was conducted to examine the
significance of prophylactic intravesical instillation of mitomycin C
(MMC) and cytosine arabinoside (Ara-C) to prevent recurrent bladder
tumors after surgery for superficial transitional cell carcinoma of the
upper urinary tract. METHODS: The patients were randomized into an
instillation group, who received postoperative intravesical instillation
of MMC (20 mg) and Ara-C (200 mg) 28 times over a period of 2 years, and
a non-instillation group. The non-recurrence rate was then compared
between the groups. RESULTS: Of the 27 patients registered, 25 patients
(13 with instillation and 12 without instillation) were able to be
evaluated, with a median follow-up period of 45 months. The
non-recurrence rate of bladder tumors in the instillation group was
higher than that in the non-instillation group. Although the difference
was not statistically significant, the P-value (P = 0.079) demonstrated
a strong trend. When any possible bias was allowed for a multivariate
analysis, the difference was almost significant (P = 0.0567). No
patients withdrew from this study due to any side-effects. CONCLUSION:
The postoperative instillation of MMC and Ara-C may be a useful approach
for reducing the recurrence of bladder tumors after surgery for upper
urinary tract tumors.
25
UI - 21283596
AU - Kim JC; Steinberg GD
TI -
Medical management of patients with refractory carcinoma in situ of the
bladder.
SO - Drugs Aging 2001;18(5):335-44
AD - Department of Surgery, University of Chicago, Pritzker School of
Medicine, Illinois, USA.
Bladder cancer is a common genitourinary malignancy and carcinoma in
situ (CIS) of the bladder exists as a potentially aggressive variant of
the superficial form of the disease. Treatment must reflect the
unpredictable nature of this disease entity. In 1976, the use of
intravesical Bacillus Calmette-Guerin (BCG) was described for the
management of early stage bladder cancer. A subsequent report
demonstrated efficacy in a cohort of patients with CIS of the bladder.
Since this time, intravesical BCG has been recognised as the initial
therapy for CIS of the bladder. Although a 6-week treatment with
intravesical BCG has been established as standard therapy in patients
with CIS, there has been no consensus as to the subsequent treatment for
patients in the setting of failure to initial management with BCG. In
addition, a number of reports have demonstrated an increased potential
of adverse effects after repeated treatment with intravesical BCG. A
variety of alternative immunological and chemotherapeutic agents have
been developed in response to the limitations of BCG for patients with
refractory CIS of the bladder. At present, valrubicin remains the only
agent that is approved by the US Food and Drug Administration for the
specific indication of CIS of the bladder unresponsive to intravesical
BCG. Although these agents appear promising, the most efficacious
therapy remains to be determined. The specific treatment protocol for
refractory CIS of the bladder remains elusive. It is ultimately the
combined decision of the clinician and patient to determine which course
of management is most beneficial.
26
UI - 21323883
AU - Vaughn DJ; Malkowicz SB
TI -
Recent developments in chemotherapy for bladder cancer.
SO - Oncology (Huntingt) 2001 Jun;15(6):763-71, 775; discussion 775-6, 779-80
AD - Department of Medicine Hematology-Oncology Division, University of
Pennsylvania School of Medicine, University of Pennsylvania Cancer
Center, Philadelphia, Pennsylvania, USA.
Invasive bladder cancer is a chemotherapy-sensitive neoplasm.
Historically, the development of cisplatin (Platinol)-based chemotherapy
regimens has represented an important advance for patients with
metastatic disease. More recently, investigations of new agents, such as
gemcitabine (Gemzar) and paclitaxel (Taxol), have resulted in further
options for these patients. Randomized trials comparing new regimens
with cisplatin-based therapies have been initiated. The role of
chemotherapy in the adjuvant and neoadjuvant settings is an area that is
undergoing active investigation. The application of prognostic
biological markers to risk-stratify patients has resulted in new avenues
of investigation in these ongoing early disease trials.
27
UI - 21523855
AU - Shirakawa T; Sasaki R; Gardner TA; Kao C; Zhang ZJ; Sugimura K; Matsuo
TI -
M; Kamidono S; Gotoh A
Drug-resistant human bladder-cancer cells are more sensitive to
adenovirus-mediated wild-type p53 gene therapy compared to
drug-sensitive cells.
SO - Int J Cancer 2001 Oct 15;94(2):282-9
AD - Department of Urology, Kobe University School of Medicine, Kobe, Japan.
toshiro@med.kobee-u.ac.jp
We investigated the therapeutic potential and molecular mechanism of
adenovirus-mediated wt p53 gene therapy for drug-resistant human bladder
cancers. KK47, a human bladder-cancer cell line, along with the
drug-resistant sublines KK47/DDP10, KK47/DDP20 (cisplatin-resistant) and
KK47/ADM (doxorubicin-resistant) were used for the experiments. All 4
KK47 cell lines had genetically normal p53 genes. Using an in vitro
cytotoxicity assay, the drug-resistant cell lines were more sensitive to
Ad-CMV-p53 cell killing than the KK47 parental cell line. Ad-CMV-p53
induced higher levels of p53 protein and mRNA in the drug-resistant cell
lines than in the parental cell line and, consequently, higher levels of
p21 and Bax mRNA, which resulted in higher percentages of G(1)
cell-cycle arrest and apoptosis. The higher efficiencies of adenoviral
gene transfer in the drug-resistant cell lines were confirmed by X-gal
staining after infection with Ad-CMV-beta-gal. In conclusion,
adenovirus-mediated wt p53 gene therapy was more effective in the
drug-resistant bladder-cancer cell lines than in the drug-sensitive
bladder-cancer cell line. Copyright 2001 Wiley-Liss, Inc.
28
UI - 21470098
AU - Morales A; Chin JL; Ramsey EW
TI -
Mycobacterial cell wall extract for treatment of carcinoma in situ of
the bladder.
SO - J Urol 2001 Nov;166(5):1633-7; discussion 1637-8
AD - Department of Urology, Queen's University, Kingston, Canada.
PURPOSE: Bacillus Calmette-Guerin (BCG) established immunotherapy as an
effective modality for carcinoma in situ of the bladder and remains the
most effective agent for treatment. However, as a live organism it has
the potential for undesirable side effects and toxicity. This result has
led to the search for other active and safer biological response
modifiers. We investigated the efficacy of a mycobacterial cell wall
extract (MCWE) from Mycobacterium phlei, which does not contain live
bacteria, for management of carcinoma in situ of the bladder in humans.
MATERIALS AND METHODS: The requirement for an emulsified preparation was
investigated with photon correlation spectroscopy to determine the
stability of the bacterial fragments. A total of 61 patients with
histologically documented carcinoma in situ completed the study. Cell
wall extract from M. phlei suspended in oil droplets to form an emulsion
were instilled into the bladder at a dose of 4 mg. once weekly for 6
weeks and then monthly for 1 year. Response assessment was performed at
3-month intervals. Complete response to treatment indicated the absence
of endoscopic and histological evidence of carcinoma in situ. Partial
responders were those cases in which cystoscopy and biopsies were
negative but cytology was suspicious for malignant cells. All other
cases were considered failures. RESULTS: The need for an emulsified
suspension of the cell wall extract was confirmed by the demonstration
that the cell wall extract alone in urine aggregated, whereas the MCWE
emulsion had remained stable. Kaplan-Meier estimates showed negative
cystoscopy and biopsies in 62.5% at 12, 49.3% at 24 and 41.1% of
patients at 60 weeks after therapy. After this point the number of
responders had remained stable. Excellent tolerance with minimal
toxicity was observed. CONCLUSIONS: Our study demonstrates clinical
activity of low doses of MCWE against human bladder cancer. The results
observed at the dosage used in our trial are less than those observed
with live BCG. However, MCWE has a better toxicity profile and can be
instilled in the presence of a disrupted urothelium. It also appears to
exhibit activity in patients in whom BCG has failed.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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